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NPI Code Detail

MEDICARE: MRS. CRYSTAL LEA MATHIS RN, MSN, WHNP

MEDICARE: MRS. CRYSTAL LEA MATHIS RN, MSN, WHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner1057018TX

General Provider Information

NPI Number : 1689339756
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRYSTAL LEA MATHIS RN, MSN, WHNP
Provider Business Mailing Address
First Line : 8500 COBBLE STONE
Second Line :
City : GODLEY
State : TX
Zip : 76044-3397
Country : US
Telephone Number : 817-304-7950
Fax Number :
Provider Business Practice Location Address
First Line : 1250 8TH AVE STE 570
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4145
Country : US
Telephone Number : 817-332-6667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2021
Last Update Date : 11/03/2021

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